| NPI | 1235199662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2006-00586) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: IL 036112967) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: IN 01060026A) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2007-11-28 |